Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN14096 | FL |
Y | 213EG0000X | General Practice | DN14096 | FL |
NPI | 1003827569 |
---|---|
Provider Name | Timothy Morris |
First Address | Melbourne, FL 32901-2636 |
Second Address | Merritt Island, FL 32952-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |